A unified system with a focus on equity

The new healthcare system in Aotearoa New Zealand (AoNZ) continues to take shape with two new announcements. The first aims to find solutions to long surgical wait times, while the second lays the foundations of a unified health system with a roadmap for 2022 to 2024. On 1 July 2022, the Pae Ora (Healthy Futures) Act came into force in the biggest shake up of AoNZ’s health service in 20 years. It established Te Whatu Ora - Health New Zealand (http://bit.ly/3tsmkGP), a national body to replace the 20 district health boards. It also created Te Aka Whai Ora - Māori Health Authority (bit. ly/3EtX09E) to improve health equity. The aim of the reforms is to lift overall public health—shifting the emphasis to illness prevention, improving access and equity, unlocking innovation, and building up the workforce. Pandemic increases the urgency to solve planned care backlog One of the major challenges facing the new system is surgical waitlists for planned care. Estimates suggest it could take between three and five years to clear the backlog, with the number of patients waiting more than a year for their first specialist appointment increasing 17-fold during the COVID-19 pandemic. There are an estimated 28,500 people waiting longer than four months for planned care. A taskforce was established in May, headed by RACS Fellow and Counties Manukau’s Chief Medical Officer Dr Andrew Connolly. On 25 October, the Planned Care Taskforce released its 101 recommendations (bit.ly/3U0rqFY), which aim to reduce the backlog, and improve equity and access. Recommendations include giving GPs the ability to diagnose without the need for a specialist, reducing the number of times patients see specialists, moving patients between regions for care, and greater use of capacity in the private sector for public patients. The taskforce also suggests expanding Māori and Pacific-focused provider services. Lack of targets – capacity issues persist While there is widespread agreement of the need to tackle planned surgery wait lists, some have noted the lack of clear time targets for change. Others, including RACS Fellow and New Zealand Association of General Surgeons president Dr Vanessa Blair, said the proposals don’t address the core reasons behind the wait lists, including workforce shortages and pay for allied health workers. Dr Blair said she wants the nursing crisis addressed by allowing nurses to come in more easily from overseas, with a fouryear plan to train more nurses, including free training. “At its core we just need to pay these people more. Nurses and other allied professions do not earn enough.” The College of GPs chair, Dr Samantha Murton, warned of capacity issues in primary care. While she said family doctors can help, they are already under the pump. “There’ll be a lot of people in the workforce going, ‘Oh another job to do’.” Interim plan to build momentum around a unified system A few days after the Taskforce recommendations were released, Te Whatu Ora and Te Aka Whai Ora unveiled the first national plan, which will underpin the new health system for the next two years.

The interim plan, Te Pae Tata (bit.ly/3DtmbHD), will serve as a roadmap until a more comprehensive strategy is developed. It has six priority actions and lays out how the government broadly plans to deliver on its health reform aims. Among its aims is to tackle hospital capacity, surgery wait times and workforce shortages. It seeks to address inequities for Māori and Pasifika, immunisation coverage and accessing specialist care. It also aims to improve outcomes for maternity and early years, people with cancer, people living with chronic health conditions, and people living with mental distress. Te Pae Tata’s priority is to place whānau (family/communities) at the heart of the system to improve equity and outcomes. Other priorities include: • embedding Te Tiriti o Waitangi, Treaty of Waitangi, across the health sector • developing an inclusive workforce • keeping people safe and well in their communities

• developing digital services to provide more care in homes and communities

• establishing the new health authorities as financially sustainable systems. The planned unveiling comes amid major pressure on the health system. Not only are planned care wait lists an issue but new data shows one in four people are waiting six hours to be seen in emergency departments. Where is the action? Similar criticism to that levelled at the Planned Care Taskforce’s recommendations have been raised in response to Te Pae Tata. The opposition National Party dismissed it as little more than a ‘discussion document’ and asked where the ‘action, dates and accountability’ are. Sarah Dalton, executive director of the Association of Salaries Medical Specialists, said Te Pae Tata will do little to address chronic workforce shortages plaguing the sector and fuelling backlogs and workforce discontent. She said, “big conversations need to be had” about how to stem the flow of senior doctors, who can double their salaries in Australia.

GPs say the new national health plan falls well short of helping overrun rural practices. RACS position RACS in AoNZ agrees the government needs to move faster and develop a long-term plan to recruit and retain a sustainable supply of skilled healthcare workers. Responding to an earlier announcement by the Planned Care Taskforce, AoNZ National Committee Chair Associate Professor Andrew MacCormick said, “The focus should not be diverted from the root cause of long waitlists and [we] have encouraged the government to accelerate plans to relieve worker shortages across the healthcare sector, address lack of resources, and develop alternative models of care.” Read the full article on the front page of the latest issue of AoNZ newsletter Cutting Edge (bit.ly/CuttingEdgeOct2022).